title: Follow-up of long-term survivors of breast cancer in primary care versus specialist attention.
abstract: BACKGROUND
  Hospitals have traditionally been the place where the follow-up of breast cancer patients occurs in Spain.
  
  
  OBJECTIVE
  To describe the evolution of long-term survivors of breast cancer according to type of follow-up received (in primary or specialist/hospital care), measuring impact of care type on health, cost, health-related quality of life (HRQL) and satisfaction results.
  
  
  METHODS
  Retrospective study of cohorts with disease-free patients followed up for at least 5 years in Oncology. Using personal questionnaires, the type and cost of the follow-up, events, HRQL and satisfaction were analysed.
  
  
  RESULTS
  Ninety-eight women were surveyed, 60 in primary and 38 in specialist care. There were no differences between groups in diagnosis of metastasis or new primary tumours. The number of annual visits per patient was 0.98 (0.48) in primary and 1.11 (0.38) in specialist care (P = 0.19). In primary, 44.6% were programmed and 55.4% on demand; in specialist, 94.6% were programmed and 5.4% on demand (P = 0.0001). The costs of follow-up in primary care were lower--€112.86 (77.54) versus €184.61 (85.87) per patient and year (P = 0.0001). No differences were reported in HRQL. Preference for specialist care was expressed by 80%, versus 10% for primary, with 10% indifferent. Patients showed greater satisfaction with specialist care in all questionnaire dimensions.
  
  
  CONCLUSIONS
  Compliance with follow-up protocol was high in both groups. In specialist care nearly all the visits were programmed and in primary almost half were on demand. In our locality, primary is more cost-effective than specialist care, but patients express greater satisfaction with specialist follow-up and hence prefer it.
authors.affiliation: Servicio de Oncología Médica, Hospital Universitario Puerta del Mar, Cádiz.
authors.forename: José M
authors.initials: JM
authors.lastname: Baena-Cañada
authors.forename: Patricia
authors.initials: P
authors.lastname: Ramírez-Daffós
authors.forename: Cristina
authors.initials: C
authors.lastname: Cortés-Carmona
authors.forename: Petra
authors.initials: P
authors.lastname: Rosado-Varela
authors.forename: Juan
authors.initials: J
authors.lastname: Nieto-Vera
authors.forename: Encarnación
authors.initials: E
authors.lastname: Benítez-Rodríguez
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008495:Medical Oncology / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D057240:Patient Preference / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011788:Quality of Life; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors
keywords: Breast cancer; follow-up care; health care models; long-term survivors.